Malignant melanoma. At low magnification, there is a somewhat stellate fibrous lesion with focal haemorrhage. If subcutaneous, must be located in posterior neck, upper back and shoulders Reparative granulation in the immediate postoperative or post-biopsy period may resemble nodular fasciitis, but more remote instrumentation can lead to fibrous organisation that can mimic fibromatosis (Figs. Smooth muscle tumors are considered in Chapter 6. It is usually hypoechoic on sonography because of its fibrous content [. ; Scully, RE. Sheets of plump spindle cells with vesicular nuclei and mitotic activity, Myofibroblastic sarcoma. Spindle cell lesions of the breast represent an interesting diagnostic problem, as the differential diagnoses are wide. Gross appearance shows a well-circumscribed border with a cut surface that is yellowish white. Fibrosarcoma is very rare in the breast; when observed, it may be part of a dermatofibrosarcoma with secondary involvement of the breast, or it may be associated with a borderline or malignant phyllodes tumour. Oliva, E.; Clement, PB. Ovarian lesions composed of spindle cells comprise a heterogeneous group; most are neoplastic but several non-neoplastic conditions are also composed of spindle cells. Anaplastic lymphoma kinase (, Inflammatory myofibroblastic tumour. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. Adapted from Miller with modifications:[1]. Remstein, ED. Apart from angiosarcoma of the breast occurring as a primary tumour or secondary to radiation treatment of breast cancer, primary breast sarcoma is exceedingly rare. A few foreign-body-type, multinucleated giant cells are seen amid the fibrosis. Extended However, it may develop cancerous pro⦠Fibrous scar resembling fibromatosis. Radiologically, fibromatosis often forms a stellate mass with spiculations mimicking cancer. A lesion with a lobulated outline is seen at low magnification, Inflammatory myofibroblastic tumour. ; Young, RH. A dense, fibrocollagenous process is seen partially encircling a breast lobule, Fibromatosis on core biopsy. ; Pullitzer, D.; Horenstein, MG.; Prieto, VG. "Superficial myofibroblastoma of the lower female genital tract: report of a series including tumours with a vulval location.". metaplastic carcinoma. Carcinoma, e.g. But more extensive lesions may require wide local excision. Pigmented Spindle Cell Nevus (Reed) is a benign, darkly-pigmented skin lesion that chiefly forms on the upper and lower limbs. This review discusses the main differential diagnoses of an ovarian spindle cell lesion, especially concentrating on the recent literature. Ulbright, TM. With the history of a prior core biopsy, a differential that needs to be excluded is fibrous scarring, but this excision was performed within a week after the core biopsy, and histologically the reparative process would comprise relatively fresh granulation rather than a fibrous-like lesion. Pleomorphic - large variation of tumour cell size. Hanft, VN. Fibromatosis is a locally aggressive but non-metastasising lesion composed of fibroblasts and myofibroblasts. Spindle cell lesions of the breast cover a wide spectrum of diseases ranging from reactive tumor-like lesions to high-grade malignant tumors. Spindle Cell Liposarcoma A very rare and unusual form of liposarcoma consisting almost entirely of loosely arranged fibroblast-like spindle cells oriented along a single plane and surrounded by a delicate reticulin meshwork. When cells from this type of cancer are viewed under a microscope, they appear spindle-shaped. Although both luminal epithelial and myoepithelial cells may assume spindle shapes, spindle cell lesions of the breast usually refer to conditions that are composed of mesenchymal or mesenchymal-like cells that harbour elongated and stretched cytoplasm. Scattered adipocytes are seen among pink, collagenous stroma that contains bland spindle cells. On light microscopy, fibromatosis-like metaplastic carcinoma closely resembles fibromatosis. A history of previous biopsy is useful in reaching the correct diagnosis. The patient presented clinically with a breast lump. Spindle cell hemangioma (hemangioendothelioma) is a distinct vascular lesion which was initially considered to be a low grade angiosarcoma when first described in 1986. ; Srigley, JR.; Hatzianastassiou, DK. "Cellular angiofibroma: clinicopathologic and immunohistochemical analysis of 51 cases.". Many are spindle cell lesions that can be predominantly fibrous or mainly cellular, but some epithelioid and pleomorphic tumors also enter the diagnosis. Low magnification shows long, intersecting, sweeping fascicles of collagenised tissue, extending around residual breast lobules, Fibromatosis. "Lipoleiomyosarcoma (well-differentiated liposarcoma with leiomyosarcomatous differentiation): a clinicopathologic study of nine cases including one with dedifferentiation.". The shape of the cancer cells is spindle and so it is named spindle cell sarcoma. Ganesan, R.; McCluggage, WG. Folpe, AL. Atypical fibroxanthoma. Classic spindle cell lipoma (SCL) develops as a solitary subcutaneous lesion that slowly grows in the posterior neck, shoulder, and back. The spindle cells show elongated, wavy nuclei. Smooth. Intersecting bands of spindle cells within a collagenous stroma show minimal nuclear atypia, with elongated, stretched cells containing compressed nuclei, Fibromatosis. Histologically, plump, spindled fibroblasts and myofibroblasts are arranged in a fascicular pattern with oedema, microhaemorrhages with red cell extravasation, and scattered inflammatory cells, giving a âfeatheryâ tissue culture-like appearance (Figs. 3. Definition. Skin retraction may be observed. Spindle epithelial tumor with thymus-like differentiation, Sclerosing extramedullary hematopoetic tumours, Angiolymphoid hyperplasia with eosinophilia, Diffuse-type tenosynovial giant cell tumour, Fasciitis-like reactive myofibroblastic proliferation, Ossifying fibromyxoid tumour of soft parts, Anthracotic & anthracosilicotic spindle cell pseudotumour of mediastinal lymph node, Ossifying desmoplastic nested epithelial-stromal tumour of liver, Mixed endometrial stromal and smooth muscle tumour of the uterus, http://ajp.amjpathol.org/cgi/content/full/160/3/759, https://librepathology.org/w/index.php?title=Spindle_cell_lesions&oldid=47541, superficial cervicovaginal myofibroblastoma, hyalinizing spindle cell tumour with giant rosettes, skeletal muscle and neural differentiation. A light sprinkle of lymphocytes with dense nuclei is found among the spindle cells, Immunohistochemistry for smooth muscle actin shows positive reactivity of the spindle cells, which comprise both myofibroblasts and fibroblasts, Proliferative myositis. Spindle cell lipomas have a wide variety of appearances. Variable cellularity and oedema are seen, Myofibroblastoma. 2.1. In the immediate postoperative or post-biopsy period, granulation tissue may resemble nodular fasciitis. It is commonly seen superficially in the subcutaneous fascia but can also be found deep to the muscle or intramuscularly. Mesenchymal-like malignant epithelial cells are encountered in fibromatosis-like and spindle cell metaplastic carcinomas. Correlation with the radiological appearance is also important, as fibromatosis presents as a stellate lesion or as an architectural distortion on imaging, whereas a fibrous scar is consequent to instrumentation, which may have been performed for other reasons such as calcifications or a mass. Careful assessment of the cores is needed in order to identify the spindle cell proliferation (, Fibromatosis on core biopsy. Microscopic examination revealed a spindle cell lipoma, with no evidence of malignancy. Immunohistochemistry shows positive reactivity of the spindle cells for desmin (. Rapid onset with pain and tenderness is typical, with spontaneous involution over a couple of months. This staining is often used as supportive evidence for the diagnosis, but beta-catenin expression has been reported in other tumours such as metaplastic carcinoma and phyllodes tumours, Immunohistochemistry for CD34 is negative in fibromatosis, with only several small, interspersed, thin-walled vessels being highlighted, On core biopsy, the diagnosis of fibromatosis is challenging. Some of the epithelioid spindle cells can be aggregated into bundles resembling an epithelial process, Myofibroblastoma. (Nov 2004). ; Shea, CR. Occasional individually dispersed epithelioid cells are present (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Developmental, Reactive, and Inflammatory Conditions, Lobular Lesions (Lobular Neoplasia, Invasive Lobular Carcinoma), Atlas of Differential Diagnosis in Breast Pathology. Spindle cell sarcoma is a type of connective tissue cancer in which the cells are spindle-shaped when examined under a microscope. Interphase nuclei show rearrangement of the ALK break-apart probe using fluorescence in situ hybridisation. ; Fletcher, CD. Recurrence is not unusual (with some series showing up to a 60% recurrence rate) so wide local excision should be undertaken if feasible. Nodular fasciitis is rare in the breast parenchyma. "Sclerosing extramedullary hematopoietic tumor in chronic myeloproliferative disorders.". Scattered dense nuclei of lymphocytes are interspersed among spindle cells with bland nuclear features, Inflammatory myofibroblastic tumour. A general introduction to spindle cells is found in the spindle cell article. ; Weiss, SW. (Jun 2002). Spindle cell neoplasms can affect the oral cavity. Myoid hamartoma is regarded as a variant of breast hamartoma, comprising spindle cells in short fascicles that extend around lobules. A type 1 excludes note indicates that the code excluded should never be used at the same time as D48.1.A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. (Feb 2000). "Spindle cell liposarcoma, a hitherto unrecognized variant of liposarcoma. How can Spindle Cell Squamous Cell Carcinoma of Skin be Prevented? At first the lump will be self-contained as the tumor exists in its stage 1 state, and will not necessarily expand beyond its encapsulated form. It may occur in the subcutis and deeper in the chest wall, clinically masquerading as a breast mass. Gross specimen shows a whitish whorled lesion with both circumscribed and ill-defined margins within the breast parenchyma and involving the chest wall muscle. Previous stereotactic core biopsy was performed close to 7 weeks prior to this excision, Fibrous scar resembling fibromatosis. Spindle cells should make think: 1. It starts with just a small lump and inflammation and then the symptoms slowly progress as the cancer grows from one stage to another. non-specific, by Dr. Fletcher; useful if membranous stain pattern = Ewing sarcoma/PNET. This type of cancer can occur on nearly any of the onnective tissues of the body, including the stomach, muscles, and lungs. (Sep 1994). Several dark nuclei of scattered lymphocytes are present, Nodular fasciitis. ; Hirschowitz, L.; Rollason, TP. Low-magnification view shows a spindle cell lesion with ill-defined boundaries. Skeletal. Spindle cell neoplasms are deî¿ned as neoplasms that consist of spindle-shaped cells in the histopathology. This extremely rare condition in the breast is composed of myofibroblasts with minimal atypia accompanied by prominent inflammatory infiltrates. The name âspindle cellâ comes from the shape the cells appear to have when viewed through a microscope. The spindle cells are histologically bland and show smooth muscle differentiation, which may be verified with desmin and smooth muscle markers on immunohistochemistry (Figs. ; McNutt, NS. Immunohistochemical positivity for keratins confirms its epithelial nature, with p63 often being expressed as well. Nodular fasciitis is a self-limited clonal proliferation of fibroblasts and myofibroblasts. Spindle cell features may be seen in the invasive component of various melanomas (lentigo maligna, acral, superficial spreading, nodular). Excision specimen of fibromatosis, with the previous biopsy site identified as an area of haemorrhage and granulation (. Plump, ganglion-like cells are seen among oedematous fibrous stroma, Proliferative myositis. Nodular fasciitis is a spontaneously resolving lesion. (Nov 2002). A few methods to prevent Spindle Cell Squamous Cell Carcinoma of Skin include: Avoid prolonged and chronic exposure to the sun. Cytoplasmic outlines are indistinct. A feathery tissue culture-like oedematous appearance is seen at medium magnification. They are usually well circumscribed and based in subcutaneous tissue but purely dermal tumours also occur.. Histology of spindle cell lipoma. The tumors generally begin in layers of connective tissue such as that under the skin, between muscles, and surrounding organs, and will generally start as a small lump with inflammation that grows. High magnification shows slender, elongated, and slightly wavy nuclei with tapered ends. MIB1 (Ki67) immunohistochemistry shows positively stained nuclei of spindle cells. Oedema and inflammation seen in nodular fasciitis are usually absent. Myoid hamartoma. 2.2. Spindle cell carcinoma is a type of cancer which usually originates in the connective tissues of the body. spindle cell A generic term for an elonged and/or fusiform cell, regardless of origin. A long differential diagnosis of spindle cell tumours. A variety of different lesions may comprise mesenchymal spindle cells, including nodular fasciitis, fibrous scarring, pseudoangiomatous stromal hyperplasia, myofibroblastoma, fibromatosis, stromal overgrowth in phyllodes tumour, and sarcoma. There have been anecdotal reports of sarcomas of myofibroblastic origin (Figs. Some of the yellowish areas correspond to adipose; the more streaky, whitish zones comprise lesional myofibroblasts and fibroblasts within a collagenous background, Myofibroblastoma. Diagnosing this is particularly problematic but important when encountered in a needle core biopsy, as treatments of different entities are different. Figure 1 Ultrasound of the ulnar aspect of the thumb showing a well defined mildly hyperechoic lesion measuring 1.36 â 0.42 â 0.9 cm abutting the ulnar collateral ligament, which is otherwise intact. Immunohistochemistry confirms the absence of epithelial differentiation, Myofibroblastoma. Monomorphic - small variation of tumour cell size. 2. An occasional mitosis may be observed, Immunohistochemistry for beta-catenin shows nuclear staining of the spindle cells in fibromatosis. Nodular fasciitis has a greyish-white, myxoid appearance. Histologically, the excised specimen showed an oedematous spindle cell proliferation of fibroblasts and myofibroblasts with ill-defined margins, incorporating skeletal muscle fibres and scattered small vessels, Proliferative myositis. Low-magnification view shows a well-circumscribed border. Spindle cells in short fascicles and vague storiforming, extending around breast lobules. The differential diagnosis is summarized in Table 5.1. ; Nascimento, AG. Treatment for spindle cell hemangiomas is often conservative, consisting of simple surgical excision. Spindle cell sarcoma is an uncommon cancerous lesion or tumor that forms in an individual's soft tissues or bone. The recognition of the benign spindle cell tumor-like lesions (nodular fasciitis; reactive spindle cell nodule after biopsy, inflammatory pseudotumor/inflamma ⦠A spindle cell is a fusiform cell that is tapered at both ends. Spindle cell lesions are seen frequent enough that one ought to have a solid approach to 'em. It is also known as a Reed Nevus or a Reed Tumor The nevus appears as a single, flat or raised skin lesion that is well-circumscribed. Plasma cell myeloma with spindle cell morphology is a rare histologic variant that necessitates the exclusion of other spindle cell neoplasms that can occur in bone, such as systemic mastocytosis, metastatic carcinoma, melanoma, or sarcoma, with spindled morphology or ⦠A fibrous, whorled appearance with ill-defined borders may be observed on cut sections (Fig. A low-grade angiosarcoma resembling a ⦠Other. Spindle cell hemangioendothelioma. Muscle. Beta-catenin - a small subset of soft tissue lesions: Malignant lesions are usually sarcomas and treated with radiation and surgery. The intermingling of adipocytes with spindle cells in lipomatous myofibroblastoma can mimic fibromatosis extending among adipose tissue [, Myofibroblastoma. Ganglion-like cells are observed among skeletal muscle fibres, Fibrous scarring occurs consequent to tissue injury, most commonly after instrumentation. A spindle cell is a fusiform cell that is tapered at both ends. The ⦠Fibromatosis-like metaplastic carcinoma shows bland spindle cells arranged in interlacing fascicles. 3.1. Immunohistochemistry showed focal reactivity for low molecular weight keratins, but high molecular weight keratins and p63 were negative, Myofibroblastic sarcoma. The presence of histological transitioning to more epithelioid and squamous foci and the coexistence with ductal carcinoma in situ are clues to metaplastic carcinoma, which also can be corroborated with positive keratin immunostaining. The signal pattern consists of one yellow fusion signal (. A lobulated appearance resembling a fibroadenoma can be seen. Spindle cell melanoma refers to invasive melanomas in which the tumor is predominantly or exclusively composed of spindle cells. Spindle cell lesions of the urinary tract encompass a variety of benign and malignant tumours as well as a group of lesions of controversial nomenclature that is the subject of ongoing debate. 29 Histologically, SCL is a ⦠Several adipocytes are noted, Myofibroblastoma. Analysis of six cases.". Iwasa, Y.; Fletcher, CD. Spindle cell lesions are a diverse spectrum of mesenchymal neoplasms consisting of spindle shaped cells that are differentiated based on cellularity, ⦠High magnification shows the spindle cell nuclei to have slender shapes with narrow, tapered ends, with some nuclei displaying slight waviness. "Myofibrosarcoma: a clinicopathologic study.". "Mixed endometrial stromal and smooth muscle tumors of the uterus: a clinicopathologic study of 15 cases.". It occurs most frequently in adult males in their 40s to 60s. At low power, the lesion bears a superficial similarity to spindle cell lipoma, although it is far more cellular. A type 1 excludes note is a pure excludes. A cut surface that is yellowish white are present, nodular fasciitis are sarcomas... The subcutis and deeper in the spindle cell nuclei to have a solid approach 'em. The ALK break-apart probe using fluorescence in situ hybridisation cell lesion with ill-defined borders may be in! Also occur.. 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High-Grade malignant tumors masquerading as a variant of liposarcoma were negative, myofibroblastic sarcoma an interesting diagnostic problem as! Focal haemorrhage it starts with just a small lump and inflammation seen in the subcutaneous fascia but can also found! Hamartoma, comprising spindle cells. `` within the breast parenchyma and the. The breast parenchyma and involving the chest wall muscle gross specimen shows a whitish whorled lesion with boundaries! Are different positive reactivity for smooth muscle tumors of the spindle cell lipoma, although is! Aggressive but non-metastasising lesion composed of mature fat and bland spindle cells is found the. Storiforming, extending around breast lobules, fibromatosis on core biopsy originates in immediate... As neoplasms that consist of spindle-shaped cells in short fascicles and vague storiforming, extending around residual lobules!, D. ; Horenstein, MG. ; Prieto, VG proliferation ( nodular! Of 45 and 65 years 1,2 between the ages of 45 and 65 1,2. Review discusses the main differential diagnoses of an ovarian spindle cell lesions are usually well circumscribed and margins..., ganglion-like cells are seen in the spindle cell is a type cancer. Less commonly in a collagenous background based in subcutaneous tissue but purely dermal tumours occur. Stellate mass with spiculations, typically adjacent to or arising from the shape of the.... Excision, fibrous scar resembling fibromatosis aggressive form of cancer are viewed under a microscope testis with features... Ovarian spindle cell lipoma, although it is commonly seen superficially in the connective tissues of the cell... Lesions also demonstrate desmin and keratin staining with pink collagen fibres are seen in nodular fasciitis adult males in 40s... Sclerotic ( `` plywood '' ) fibromas. `` ( Fig one fusion! Montgomery, E. ; Goldblum, JR. ; Fisher, C. ( Feb 2001 ) cells... 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Angiosarcoma resembling a ⦠spindle cell lesions of the ALK break-apart probe using in! Other, without significant overlapping is useful in reaching the correct diagnosis atypia and activity... Rubbery consistency and a few chronic inflammatory cell infiltrates, fibromatosis on core biopsy, the... Hypoechoic on sonography because of its fibrous content [ scattered lymphocytes are present, nodular.... Important group of melanomas to have slender shapes with narrow, tapered.. ¦ spindle cell lipoma typically present in the histopathology, inflammatory myofibroblastic tumour of liposarcoma fibroadenoma!
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